Abstract Aims The study's aim is to report the first documented paediatric case of generalized Erythema Scarlatiniforme Desquamativum Recidivans (ESDR), or Féréol‐Besnier disease, induced by amoxicillin and to assess the cross‐reactivity profile to other beta‐lactam antibiotics. Methods An 8‐year‐old boy with a history of recurrent episodes of diffuse, itchy erythema and subsequent lamellar desquamation following amoxicillin/amoxicillin–clavulanic acid intake was assessed. Causality was evaluated based on clinical history, exclusion of infectious and other drug‐related etiologies, skin biopsy and a positive oral provocation test (OPT) with amoxicillin. Cross‐reactivity to other beta‐lactams was assessed using OPTs with phenoxymethylpenicillin, oxacillin, and cefadroxil. Causality was scored using the Naranjo probability scale. Results The temporal relationship, resolution after drug withdrawal, and a positive amoxicillin OPT confirmed the diagnosis of amoxicillin‐induced generalized ESDR. The Naranjo score was 8, classifying the reaction as ‘probable’ triggered by amoxicillin. Intradermal and patch tests to amoxicillin–clavulanic acid were negative. The OPTs for phenoxymethylpenicillin and oxacillin were negative. However, the OPT with cefadroxil yielded a positive reaction at the second step (one fourth of the daily dose), indicating a selective aminopenicillin–aminocephalosporin cross‐reactivity. Conclusions This case establishes the first report of generalized ESDR triggered by amoxicillin in a paediatric patient. It emphasizes a unique pattern of drug hypersensitivity, characterized by cross‐reactivity to cefadroxil and tolerance to other tested penicillins (phenoxymethylpenicillin and oxacillin). It is essential to conduct a complete allergy work‐up, which includes OPTs, to conduct a customized cross‐reactivity assessment. This assessment is essential for the safe guidance of future therapeutic decisions in patients with drug‐induced ESDR.
Bouraoui et al. (Fri,) studied this question.